Fee watch: Final conversion factor dips again, falling below proposal
By: Richard Scott
Prepare for a larger decrease to the Part B conversion factor (CF), one of CMS’ primary rate-setting mechanisms, in CY 2027. Rates are down across all four CFs in the new year. That’s according to the final 2027 Medicare physician fee schedule, a 2,468-page, policy- and fee-setting set of regulations that CMS released Nov. 4.
Controversial modifier 25 pay cut pared back, but not abandoned
By: Julia Kyles, CPC
CMS revised its plan to reduce payments when a provider reports an office/other outpatient E/M service with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on the same day as a procedure with a 0-, 10- or 90-day global period.
CMS replaces visit-complexity G2211 with modifiers, confirms incident-to telehealth
By: Julia Kyles, CPC
Alert staff to changes involving modifiers that will go into effect Jan. 1, 2027. The update includes two modifiers that will replace G2211 and change your payments, as well as a modifier for incident-to services performed via telehealth.
Part B News Features
Ask a Part B News Expert
Question: If our pain management doctors have their imaging read on their behalf by a radiologist (using our imaging equipment) and our doctor performs and documents their own independent interpreta... More
NPP Report
Recent changes mandated by Congress and CMS that boost the status of physician assistants (PA) — or physician associates, as some groups prefer — is another sign that the providers formerl... More
Benchmark of the Week
CMS will go forward with a modified plan to reduce total payments when a practice reports modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on t... More
Ask a Part B News Expert
Question: If our pain management doctors have their imaging read on their behalf by a radiologist (using our imaging equipment) and our doctor performs and documents their own independent interpreta... More
NPP Report
Recent changes mandated by Congress and CMS that boost the status of physician assistants (PA) — or physician associates, as some groups prefer — is another sign that the providers formerl... More
Benchmark of the Week
CMS will go forward with a modified plan to reduce total payments when a practice reports modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on t... More
choose your feature view ► Ask Part B News & NPP Report Benchmark of the Week & Ask Part B News NPP Report & Benchmark of the Week
Part B News Blog
Nov 4, 2026
Breaking: Final 2027 Medicare physician fee schedule ups pay cuts, ushers in payment modifiers
by: Richard Scott
Oct 26, 2026
Tackle 3 cybersecurity priorities now: Expert
by: Richard Scott
Oct 13, 2026
CPT 2027 refresh delivers E/M updates, MDM clarity and hundreds of new codes
by: Laura Evans, CPC, Julia Kyles, CPC, and Richard Scott
Tools
Payment impact: Codes subject to the final 2027 PFS modifier 25 cut
Provide your staff with a quick guide to the codes that are subject to the modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) pay cut and how the 20% cut affects the average reimbursement for each code.
Update to the list of designated health services – 2026
Find the latest list of designated health services (DHS) that are subject to the Stark physician self-referral rule’s restriction on referrals. The new list went into effect Jan. 1, 2026.
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Benchmark of the Week
Modifier 25 pay reduction includes procedures across the code set
CMS will go forward with a modified plan to reduce total payments when a practice reports modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) with an office/other outpatient service.
Hospital E/M code use stable; watch billing policies to keep steady
Like 2024, 2025 was a year of stasis in use and denial of inpatient-or-observation E/M codes. But providers who are called upon to use them should still watch for changes in billing practices from year to year.
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Learning Opportunities
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